Ultrasound variations of diaphragm activity between prone position versus supine position in ventilated patients: a cross-sectional comparative study

Purpose To evaluate the effect of the positioning from the supine position (SP) to the prone position (PP) on the diaphragm activity in ventilated patients; using the ultrasound (US) imaging. Methods A cross-sectional comparative study before/after PP was conducted on 40 ICU patients over 18 years who received invasive ventilation (IV) for at least 48 h. The considered ventilator modes were: assisted control volume with a low trigger flow (between - 2 and 2 L/mn) and pressure support mode. US diaphragmatic assessments were performed at SP and at 60 min of PP. Both End-inspiratory and End-expiratory diameters (EID/EED) were taken at 3 levels of axillary lines and determined by the average values of multiple measures. Diaphragmatic thickening fraction (DTF) was calculated as: DTF = (EID - EED/EED) x 100. Pairing and ANOVA tests were used for comparisons. Results Forty ventilated patients (42 years of median age) at 4 days [2-7] of median duration of ventilation were examined during the two positions: SP versus PP. EID decreased from the SP to the PP (2.8 mm in SP vs. 2.4 mm in PP,p = 0.001). No difference was showed regarding the expiratory thickness. Overall, DTF didn't change in PP (37.4 vs. 42.05%,p = 0.36). When the patient was placed in PP, the best DTF value was showed at the posterior part of diaphragm (posterior: 45%, median: 31% and anterior: 38%,p = 0.049). Conclusion The ventral placement in ventilated patients reduced end-inspiratory diameter and tended to decrease DTF. In PP, the best contractile activity was detected at the posterior region of diaphragm.